Provider Demographics
NPI:1568498822
Name:GAIL P BALLWEG MD PA
Entity Type:Organization
Organization Name:GAIL P BALLWEG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:BALLWEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-6777
Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-438-9112
Mailing Address - Fax:954-433-7402
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:SUITE 406
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-438-9112
Practice Address - Fax:954-433-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63586Medicare UPIN
FLBH052Medicare PIN